Background:
Chlamydia and gonorrhea are the most commonly reported notifiable Sexually Transmitted Disease in the US and Puerto Rico (PR). Both infections are a major cause of pelvic inflammatory disease and can facilitate the transmission of HIV infection.

Objective:
To describe the epidemiology of Chlamydia and Gonorrhea in PR by age, gender, and health region.

Method:
Data from the US Census Bureau and PR STD Surveillance Office was used to describe the demographic characteristics and geographic distribution of Chlamydia and Gonorrhea in PR from 1991 through 2004.

Result:
From 1991 through 2004, the rates of reported chlamydial infection increased from 2.07 to 92.66 cases per 100,000 population. From 2000 to 2004, the rates of chlamydia were highest among women and men aged 20-24 years.
From 1991 through 2004, the rates of gonorrhea in PR decreased from 16.58 to 7.15 per 100,000 population. From 2000 to 2004, the rates of gonorrhea were highest among women and men aged 20-24 years.
In 2004, the chlamydia and gonorrhea rates in the Metro and Fajardo health regions were the highest among the health regions of PR.


Conclusion:
From 1991 through 2004, the chlamydia rate increased by 4,376%, and the gonorrhea rate declined by 56.8% in PR. It is likely that the continuing increase in the number of reported chlamydia cases represents the further expansion of screening for this infection , the development and use of more sensitive screening test, and more complete reporting.
The decrease in gonorrhea rates may be masked by changes in screening practices, use of diagnostic tests with different sensitivities, and changes in reporting practices.


Implications:
Establishing and implementing strategies for Chlamydia screening and diagnostic testing in young women may increase early detection and treatment.
Further research is needed to define the risk factors associated with gonorrhea infections and co-infection with chlamydia.